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A fully revised second edition of a practical, easy-to-read and evidence-based text to assist healthcare professionals in the approach to the unstable and critically ill patient. Divided into sections by clinical scenario, the book covers the essential topics most often encountered in the emergency department and intensive care unit. A collaborative project from critical care physicians across multiple different specialties, the text covers general critical care, trauma and end-of-life care as well as emergencies across the spectrum of acute care medicine. The portable format and bulleted content provides practitioners with instant access to the essential information necessary for the diagnosis and management of critical care patients. The book is detailed while remaining focused and succinct, building on the first edition with new infographics for quick review and retention of key concepts. It is an invaluable bedside resource for emergency medicine and critical care clinicians across the acute care medicine spectrum.
Experts from the top hospitals in America's largest cities provide their insights into the disease states, injuries, patient populations, practice barriers, and societal conditions which present disproportionality in urban emergency departments. Distilling the authors' special expertise and skills in a clear and user-friendly way, this book enables the reader to recognize the impact of healthcare disparities on patient well-being and identify and manage the needs of special patient populations, including victims of substance abuse and intimate partner violence. Clinical chapters define conditions through case studies, discussing their prevalence in the urban setting, and offer expert advice for immediate and effective management. In addition, the book helpfully provides context and valuable tips for best practice and introduces new ways of thinking about the diseases and the problems discussed. Essential reading for clinicians looking to improve their knowledge of urban emergency medicine, from students through to senior attending practitioners.
Trauma is the fourth leading cause of death overall in the United States and the number one cause of death for ages 1 to 44 – second only to heart disease and cancer in those older than 45 (CDC).1 As the disease burden from infectious diseases declines and secondary prevention of chronic conditions improves, the relative importance of the practice of trauma care becomes even more apparent. Though safety engineering has improved across many industries (one need only consider examples such as crosswalk and bike lane planning, football helmet technology, and motor vehicle computerized improvements), trauma remains a significant threat to life and limb in emergency medicine.
Acute resuscitation and care of unstable and critically ill patients can be a daunting experience for all trainees in the emergency department or the intensive care unit. The practical, easy-to-read and evidence-based information in Practical Emergency Resuscitation and Critical Care will help all physicians understand and begin management of these patients. This book offers the collaborative expertise of dozens of critical care physicians from different specialities, including but not limited to: emergency medicine, surgery, medicine and anaesthesia. Divided into sections by medical entities, it covers essential topics that are likely to be encountered in the emergency department where critical care often begins. The portable format and bullet point style content allows all practitioners instant access to the principle information that is necessary for the diagnosis and management of critical care patients.
This chapter discusses the diagnosis, evaluation and management of neutropenic fever. The initial presentation of the critically ill with neutropenic fever may be overt with a clinical presentation similar to that of septic shock and including hypotension, respiratory failure, or any other major organ dysfunction. It may also be cryptogenic with isolated confusion, coagulopathy, or cardiac arrhythmias. Elderly patients and those taking steroids may present as hypothermic or euthermic. Any unexplained acute clinical deterioration should be considered a fever equivalent. Critically ill patients with neutropenic fever will most frequently present with common infections. However, their immunocompromised state places them at risk for more complex disease processes of almost any organ system. The pathophysiology of the decompensating patient with neutropenic fever is similar to that of a patient in septic shock. Those patients should be resuscitated similarly by the rapid and aggressive administration of crystalloids.
This chapter discusses the management of trauma. The primary survey for a trauma patient is performed with regard to airway, breathing and circulation. Several airway adjuncts are available to assist in endotracheal intubation, including the gum elastic bougie, supraglottic airway devices, videolaryngoscopy, or fiberoptic scopes. The breathing evaluation include visualization of chest rise, auscultation of breath sounds, palpation of the chest wall feeling for crepitus or flail segments, and assuring that the trachea is midline. The patient is examined for signs of hemorrhage, including all compartments that can hold life-threatening amounts of blood loss. Evaluation for disability in the primary survey should include Glasgow Coma Scale (GCS), neurological examination to rule out neurological deficit, and pupil examination for signs of intracranial injury. Emergency department thoracotomy (EDT) is a resuscitative procedure that has low survival rate and should be performed in unique circumstances.
This chapter discusses the diagnosis, evaluation and management of rhabdomyolysis. Physical examination of a patient with rhabdomyolysis may reveal muscle swelling and tenderness, with occasional skin changes including discoloration, induration, and blistering. It is possible for rhabdomyolysis to present without any of these signs or symptoms, making serum markers essential to the diagnosis. Severe cases may present with hypovolemic shock, acute kidney injury (AKI), metabolic acidosis, disseminated intravascular coagulation (DIC), compartment syndrome, hyperkalemia, and cardiac arrhythmias. Compartment syndrome occurs due to swelling and edema of the injured muscle: classic physical examination findings include pain, paresthesias, paralysis, pallor, and pulselessness. The cornerstone of management includes discontinuation of inciting factors and aggressive management of fluid and electrolyte abnormalities. Intravenous fluids enhance renal perfusion and increase urinary flow in order to prevent AKI and increase potassium excretion.